Individual ProviderTiffany Ann AvernaPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address3400 Spruce St, Philadelphia, PA 19104-4206(215) 615-5858PECOS EnrollmentBased on the most recent information from CMS, provider Tiffany Ann Averna does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1700121050Provider TypeIndividualFull NameAverna, Tiffany AnnCredentialPA-CGenderFemaleSole ProprietorNoEnumeration Date11/27/2012Last Updated12/21/2012Contact InformationPractice LocationPractice Address3400 Spruce St, Philadelphia, PA 19104-4206Phone(215) 615-5858FaxUnlisted FaxMailing LocationMailing Address3400 Spruce St, Philadelphia, PA 19104-4206Phone(215) 615-5858FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363AM0700XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicenseMA055929Pennsylvania